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MACs Resume Medical Review on a Post-payment Basis

Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The...

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OMHA Further Expands the Settlement Conference Facilitation Parameters

By Sandra Gauron, Audit and Appeals Coordinator In an effort to provide Administrative Law Judge (ALJ) backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014.  SCF is an alternative dispute resolution...

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CMS ABN form updated

CMS has updated the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131). Providers can use the new form now, and mandatory use of the form will be on 8/31/2020. The form is valid through 06/30/2023. On or after 8/31/2020, issuing an ABN...

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The van Halem Group Announces New Partnership with Össur Americas, Inc.

The van Halem Group will be partnering with Össur Americas, Inc., a global manufacturer of orthotic and prosthetic products. As part of this agreement, The van Halem Group will provide clinical prescreen reviews and appeal services for custom orthotics...

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Hospital Beds and Manual Wheelchairs added to RAC Approved Issues

CMS has approved two new topics for the DMEPOS RAC, Performant, to begin reviewing, effective March 1, 2020. Hospital Beds: Medical Necessity and Documentation Requirements Description: Hospital Beds must meet basic coverage criteria whether at...

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Medicare Documentation Job Aid for Doctors of Chiropractic

By Abrielle Uritz, RN, BSN, CPC, CEMC As a Doctor of Chiropractic, responding to a medical records request can be challenging; however, the A and B MACs have created a tool that will help to adequately respond to these requests. This includes guidance...

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Minor Claim Processing Error…… What is the next step?

By Kim Turner, RN No matter how careful, Medicare claim mistakes will happen. When they do, your claim may not be able to be processed by the DME MAC. Listed below are some common errors which prevent your claim from being processed. If you find a...

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SMRC warns 'No Response Providers' of E & M audit risk

In the SMRC's (Supplemental Medical Review Contractor) most recent current project detail for Diabetic Test Strips, they include verbiage that not only impacts the DME supplier, but also the ordering practitioner. Specifically the SMRC's current...

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RAC adds Surgical Dressings and Cervical Orthoses to their approved issues

Effective January 1, 2020, Performant will begin reviewing Surgical Dressings and Cervical Orthoses. Details are provided below. Surgical Dressings: Medical Necessity and Documentation Requirements Description: This review will determine...

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New HCPCS for 2020

By Kim Turner, RN, Clinical Consultant Key points from the CMS CR 11570 New DMEPOS HCPCS codes have been added to the HCPCS file effective January 1, 2020.  Suppliers can start using the new codes for billing effective on January 1, 2020. There...

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